Guideline
ASGE guideline: colorectal cancer screening and surveillance

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Introduction

Colorectal cancer (CRC) is the fourth most commonly diagnosed cancer and the second leading cause of cancer-related deaths in the United States.2 Each year, approximately 140,000 individuals are diagnosed with CRC and more than 50,000 will die from this malignancy.2 The 5-year survival rate for early-stage cancers is greater than 90%, whereas the 5-year survival rate for those diagnosed with widespread cancer is less than 10%.3 There is indirect evidence that most cancers develop from adenomatous polyps and that on average it takes 10 years for a <1 cm polyp to transform into invasive CRC.4, 5 Given the finding that adenomatous polyps are precursors to cancer and that polyps and early cancers are usually asymptomatic, there is a strong rationale to support screening asymptomatic individuals for early cancer detection and prevention.

Section snippets

Risk stratification

Approximately 30% of individuals harbor risk factors for CRC.6 These risk factors include family or personal history of CRC or adenomatous polyps, personal history of inflammatory bowel disease, and familial polyposis syndromes (including familial adenomatous polyposis [FAP] and hereditary nonpolyposis colon cancer [HNPCC]). The other 70% of individuals are considered average risk.

Personal history of inflammatory bowel disease

Individuals with long-standing ulcerative colitis (UC) and extensive Crohn's colitis are at increased risk for development of dysplasia and CRC, and they should undergo colonoscopic surveillance. The risk of CRC increases with the duration and extent of colitis, family history of CRC, continuing active colitis, young age at onset of disease, presence of backwash ileitis, and personal history of primary sclerosing cholangitis.96, 97, 98, 99, 100 The presence of proctitis alone does not appear to

Management of colonic polyps during flexible sigmoidoscopy

The decision to perform colonoscopy after the detection of a small adenoma on flexible sigmoidoscopy is controversial and should be individualized.40 Colonoscopy is the preferred method of examination of the colon after a flexible sigmoidoscopy with at least one adenoma found because it allows both the detection and removal of synchronous polyps. Controversy remains regarding whether individuals with small tubular adenomas (<1 cm) should undergo colonoscopy.120, 121 Factors associated with an

Management of colon polyps during colonoscopy

Most polyps seen during colonoscopy can be completely removed. The safety of polypectomy has been substantiated by the low incidence of complications reported in numerous series.25 The endoscopist should be prepared to perform a total examination and remove all polyps found at the time of the first colonoscopy, although technical factors encountered during colonoscopy may limit completion of the procedure. Every effort should be made to avoid repetitive procedures. Although controversy still

Summary

  • Colonoscopy is the preferred modality for CRC screening in average risk patients (B).

  • Alternative methods for CRC screening in average-risk patients include yearly fecal occult blood testing (A), flexible sigmoidoscopy every 5 years, combined yearly FOBT and flexible sigmoidoscopy every 5 years (B).

  • Single digital rectal examination FOBT has a poor sensitivity for CRC and should not be performed as a primary screening method (A).

  • Studies evaluating virtual colonoscopy and fecal DNA testing for CRC

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